See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/235267364

A critical review of patient satisfaction

Article · February 2009

DOI: 10.1108/17511870910927994

CITATIONS READS
204 19,021

2 authors, including:

Liz Gill
The University of Sydney
32 PUBLICATIONS   565 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

A health economic model for the development and evaluation of innovations in aged care: an application to Consumer Directed Care View
project

PhD Thesis View project

All content following this page was uploaded by Liz Gill on 06 June 2014.

The user has requested enhancement of the downloaded file.

 The current issue and full text archive of this journal is available at
www.emeraldinsight.com/1751-1879.htm

LHS
22,1 A critical review of patient
satisfaction
Liz Gill and Lesley White
8 Faculty of Pharmacy, The University of Sydney, Sydney, Australia

Abstract
Purpose – This paper aims to review the patient satisfaction literature, specifically meta-analyses,
which critically analyses its theory and use; then to present evidence for perceived service quality as a
separate and more advanced construct.
Design/methodology/approach – Papers that judiciously review the development and application
of patient satisfaction were identified; along with studies addressing the conceptual and
methodological deficiencies associated with the concept; and the current perceived service quality
theory.
Findings – Patient satisfaction has been extensively studied and considerable effort has gone into
developing survey instruments to measure it. However, most reviews have been critical of its use, since
there is rarely any theoretical or conceptual development of the patient satisfaction concept. The
construct has little standardisation, low reliability and uncertain validity. It continues to be used
interchangeably with, and as a proxy for, perceived service quality, which is a conceptually different
and superior construct.
Practical implications – The persistent use of patient satisfaction to evaluate the client’s
perception of the quality of a health service is seriously flawed. The key to solving this dilemma may
be for the healthcare sector to focus on perceived health service quality by considering the specific
concepts and models that can be found in the services marketing literature. This literature offers more
advanced consumer theories which are better differentiated and tested than existing healthcare
satisfaction models.
Originality/value – The paper points out that there is an urgent need for differentiation and
standardisation of satisfaction and service quality definitions and constructs, and argues for research
to focus on measuring perceived health service quality.
Keywords Patients, Health services, Quality management, Customer satisfaction, Australia
Paper type Literature review

Leadership in Health Services
Vol. 22 No. 1, 2009
pp. 8-19
q Emerald Group Publishing Limited
1751-1879
DOI 10.1108/17511870910927994
1. Introduction
Understanding satisfaction and service quality have, for some considerable time, been
recognised as critical to developing service improvement strategies. The inaugural
quality assurance work of Donabedian (1980) identified the importance of patient
satisfaction as well as providing much of the basis for research in the area of quality
assurance in healthcare. In the healthcare sector, the importance of measuring patient
satisfaction is well articulated (Lin and Kelly, 1995) with patient satisfaction having
been studied and measured extensively as a stand alone construct and as a component
of outcome quality (Heidegger et al., 2006) and in particular in quality care assessment
studies (Sofaer and Firminger, 2005). Furthermore, the literature tells us that the
concept of satisfaction is complicated (Heidegger et al., 2006), irrespective of the area in
which it is studied. It is a multidimensional concept; not yet tightly defined; and part of
an apparently yet to be determined complex model. (Hawthorne, 2006).
Significant divergence can be found in the recent healthcare literature, for example
Gonzales et al. (2005) noted that satisfaction questionnaires have been the most
commonly used method to survey patient perceptions of healthcare for more than 30 A review of
years, but only over the previous five years, had studies tried to ensure that the validity patient
of the instrument was well grounded. Yet in contrast, the main finding of a 2006 review
of the patient satisfaction literature (Hawthorne, 2006) concluded that none of the satisfaction
instruments reviewed could be considered satisfactory. Hawthorne indicated that there
were thousands of patient satisfaction measures available, which have been developed
on an “ad hoc” basis, with insufficient evidence of their psychometric properties. 9
Further, quality in healthcare has been studied largely from the clinical perspective,
excluding the patient’s perception of service quality. According to Crowe et al. (2002),
the subjective affective component of the patient satisfaction construct makes its
measurement “probably a hopeless quest” and its study is largely fraught as it has
lacked precision, at the expense of exact science, with many researchers having
undertaken studies of a purely exploratory nature (Gilbert and Veloutsou, 2006).
This article specifically reviews the health literature which: critiques the conceptual
background to patient satisfaction; identifies and summarises the findings of
meta-analyses of patient satisfaction in healthcare and its measurement; highlights the
operational issues surrounding patient satisfaction and patient perception of health
service quality; and analyses the existing focus of healthcare quality. It also considers
the services literature for both the satisfaction and perceived service quality constructs,
and concludes that after three decades of research, there is still no universally accepted
conceptualisation for them. It suggests that given the substantial theoretical progress
that has been made in the services literature, it is time for integrated research and for
health researchers to move outside of their health research silos and to study
satisfaction and perceived service quality in healthcare with a clear link back to this
general services literature.

2. Summary of the theories of patient satisfaction in healthcare

The major patient satisfaction theories were published in the 1980s with more recent
theories being largely “restatements” of those theories (Hawthorne, 2006). Five key
theories can be identified:
(1) Discrepancy and transgression theories of Fox and Storms (1981) advocated
that as patients’ healthcare orientations differed and provider conditions of care
differed, that if orientations and conditions were congruent then patients were
satisfied, if not, then they were dissatisfied.
(2) Expectancy-value theory of Linder-Pelz (1982) postulated that satisfaction was
mediated by personal beliefs and values about care as well as prior expectations
about care. Linder-Pelz identified the important relationship between
expectations and variance in satisfaction ratings and offered an operational
definition for patient satisfaction as “positive evaluations of distinct dimensions
of healthcare” (p578). The Linder-Pelz model was developed by Pascoe (1983) to
take into account the influence of expectations on satisfaction and then further
developed by Strasser et al. (1993) to create a six factor psychological model:
cognitive and affective perception formation; multidimensional construct;
dynamic process; attitudinal response; iterative; and ameliorated by individual
difference.
LHS (3) Determinants and components theory of Ware et al. (1983) propounded that
22,1 patient satisfaction was a function of patients’ subjective responses to
experienced care mediated by their personal preferences and expectations.
(4) Multiple models theory of Fitzpatrick and Hopkins (1983) argued that
expectations were socially mediated, reflecting the health goals of the patient
and the extent to which illness and healthcare violated the patient’s personal
10 sense of self.
(5) Healthcare quality theory of Donabedian (1980) proposed that satisfaction was
the principal outcome of the interpersonal process of care. He argued that the
expression of satisfaction or dissatisfaction is the patient’s judgement on the
quality of care in all its aspects, but particularly in relation to the interpersonal
component of care.

3. The application of patient satisfaction in healthcare

The desired need for the measurement of patient satisfaction has been largely driven
by the underlying politics of “new public management” (Hood, 1995) and the
concomitant rise in the health consumer movement, with patient satisfaction being one
of the articulated goals of healthcare delivery. With the advent of the patient rights
movement (Williams, 1994), the debate over the relationship between patient
satisfaction as a valuation of the process of care versus the standard of technical care
was well established. As a result, the use of patient satisfaction measures in the health
sector became increasingly widespread. For example, assessing patient satisfaction
has been mandatory for French hospitals since 1998, which is used to improve the
hospital environment, patient amenities and facilities in a consumerist sense, but not
necessarily to improve care (Boyer et al., 2006).
Whilst there are numerous specific patient satisfaction studies published in peer
reviewed journals, there is a smaller body of work which critically reviews the
literature and analyses the construct and its use. This work highlights agreement that
patient satisfaction suffers from inadequate conceptualisation of the construct, a
situation that has not changed significantly since the 1970s, and there is no agreed
definition (Hawthorne, 2006). Crowe et al. (2002) identified 37 studies investigating
methodological issues and 138 studies investigating the determinants of satisfaction.
They indicated that there is agreement that the definitive conceptualisation of
satisfaction with healthcare has still not been achieved and that understanding the
process by which a patient becomes satisfied or dissatisfied remains unanswered.
They suggest that satisfaction is a relative concept and that it only implies adequate
service. Further, both Crowe et al. (2002) and Urden (2002) separately point out that
patient satisfaction is a cognitive evaluation of the service that is emotionally affected,
and it is therefore an individual subjective perception. Crowe et al. (2002) also highlight
that there is consistent evidence across settings that the most important determinants
of satisfaction are the interpersonal relationships and their related aspects of care.
What is agreed is that satisfaction has become an endpoint in outcomes research and
the benchmarking of services. Patient satisfaction has come to be seen as a part of
health outcome quality which also encompasses the clinical results, economic
measures and health related quality of life (Heidegger et al., 2006).
4. Instruments to measure patient satisfaction in healthcare A review of
The work of Hulka et al. (1970) began the initial steps to measure patient satisfaction in patient
the healthcare area with the development of the “Satisfaction with Physician and
Primary Care Scale”. This was followed by Ware and Snyder (1975) with their “Patient satisfaction
Satisfaction Questionnaire”, aimed at assisting with the planning, administration and
evaluation of health service delivery programs. At the end of the 1970s, the “Client
Satisfaction Questionnaire” was developed by Larsen et al. (1979) as an eight-item scale 11
for assessing general patient satisfaction with healthcare services, and was superseded
by their “Patient Satisfaction Scale” (1984). Since that time, numerous instruments
have been developed but the question remains as to how valid and reliable those
instruments really are. Further, the measurement of satisfaction varies depending on
the assumptions that are made as to what satisfaction means (Gilbert et al., 2004) and a
number of approaches to measurement can be identified: expectancy-disconfirmation;
performance only; technical-functional split; satisfaction versus service quality; and
attribute importance (Gilbert and Veloutsou, 2006).
Nguyen et al. (1983) indicated that, in the absence of standardised instruments as
well as satisfaction scores across studies being so high, it was almost impossible to
make meaningful comparisons between different patient satisfaction scale scores.
Further Ware et al. (1983) reported that between 40 and 60 percent of respondents
exhibited some form of acquiescent response set bias, and Coyle and Williams (1999)
argued that dependence prevented patients reporting dissatisfaction. In addition most
patient satisfaction tools have been developed in the USA for “ad hoc” hospital use
(Hardy et al., 1996). van Campen et al. (1995) noted that patient satisfaction had been
extensively investigated, identifying over 3,000 published articles and “dozens” of
measuring instruments developed in the ten years prior to their review. Interestingly,
they noted that quality of care from the patient’s perspective (QCPP) had often been
measured as patient satisfaction. They reported that only five of 113 selected
instruments were theoretically or methodologically rigorous, and of those five, only
two that had been used were actually designed to measure perceived service quality,
SERVQUAL (Parasuraman et al., 1988) and the Patient Judgment of Hospital Quality
instrument (Meterko et al., 1990), with the latter being the only one which offered a
method for generating items that directly represented patients’ views. However, it
should be noted that whilst SERVQUAL has been used in healthcare, it was not
designed specifically to measure perceived health service quality and it certainly does
not measure satisfaction. A review by Sitzia (1999) found that 81 percent of studies
used a new instrument, an additional 10 percent had modified an existing instrument
and 60 percent failed to report any psychometric data. Sitzia concluded that the
instruments evaluated by the meta-analysis demonstrated little evidence of reliability
or validity. A more recent extensive review of patient satisfaction measures identified
over 38,000 articles on patient satisfaction using the Medline/Pub Med database plus
over 10,000 web sites through internet based search (Hawthorne, 2006). This study
assessed instruments that met its criteria for inclusion and highlighted that most
papers did not adequately report patient satisfaction; few reported the instrument used,
their psychometric properties or the actual results; and most reported patient
satisfaction based on a single item.
A number of meta-analyses of patient satisfaction studies have been conducted
(Pascoe, 1983; van Campen et al., 1995; Sitzia, 1999; Crowe et al., 2002; and Hawthorne,
LHS 2006). These authors reported little evidence of a well-developed research model or a
22,1 defined methodology. Table I provides a summary of these meta-analyses.

5. Satisfaction in the services marketing sector

To demonstrate the unresolved conceptual difficulties with the satisfaction construct,
in the services literature it is depicted as: both a summary psychological state and
12 encounter specific (Oliver, 1981); the discrepancy between prior expectations and
actual performance (Yi, 1990); comprised of both affective and cognitive components;
an outcome state (Oliver, 1989); the fulfilment response and an experiential construct
(Oliver, 1997); a response to both process and outcome (Hill, 2003). Given the range of
definitions, there has been contention in the marketing literature on how to
conceptualise and measure the service recipient satisfaction concept. The study of
customer satisfaction has largely been driven by the desire to understand the
behavioural intentions of customers (Cronin et al., 2000); however its measurement
varies depending on the assumptions that are made as to what satisfaction means
(Gilbert et al., 2004). A number of main approaches to measurement can be identified:
expectancy-disconfirmation; performance only; technical-functional split; satisfaction
versus service quality; and attribute importance (Gilbert and Veloutsou, 2006).

6. Patient satisfaction and perceived service quality in healthcare

Healthcare sector research into patients’ perceptions of the dimensions of service
quality (perceived service quality) has been limited (Clemes et al., 2001), yet studies
seeking to assess the components of the quality of care in health services
predominately continue to measure patient satisfaction (Lee et al., 2006),. There is no
consensus on how to best conceptualise the relationship between patient satisfaction
and their perceptions of the quality of their healthcare. O’Connor and Shewchuk (2003)
emphasised that much of the work on patient satisfaction is based on simple
descriptive and correlation analyses with no theoretical framework. They concluded
that, with regard to health services, the focus should be on measuring technical and
functional (how care is delivered) quality and not patient satisfaction.
A study by Gotlieb et al. (1994) on patient discharge, hospital perceived service
quality and satisfaction offered evidence of a clear distinction between perceived
service quality and patient satisfaction. They found that patient satisfaction mediated
the effect of perceived service quality on behavioural intentions, which included
adherence to treatment regimes and following provider advice. Cleary and
Edgman-Levitan (1997) pointed out that satisfaction surveys in the health care
sector did not measure quality of care as they did not include important aspects of care
items such as being treated with respect and being involved in treatment decisions. In
addition, Taylor (1999) highlighted that confusion continued in the sector regarding the
differentiation of service quality from satisfaction and reported that some authors, for
example Kleinsorge and Koenig (1991), referred to them as synonymous terms.
Nevertheless patient satisfaction continues to be measured as a proxy for the patient’s
assessment of service quality (Turris, 2005).

7. Consumers and healthcare quality

The traditional concept of healthcare relationships is based on three primary
assumptions: the professional is the expert; the system is the gatekeeper for socially
 Study authors
Pascoe (1983) van Campen et al. (1995) Sitzia (1999) Crowe et al. (2002) Hawthorne (2006)

Study details
Sample size Not specified 165 195 176 (139 determinants of 130
(No. studies) satisfaction; 37
methodological)
Data form All quantitative Quantitative 93 per cent Quantitative; 7 per cent Qualitative; 11 All quantitative
7 per cent Qualitative per cent mixed method
Inclusion patient Not addressed Only one study 11 per cent Not addressed Not addressed
views
Key findings
Theory/construct Poor None based on theory Poor Recognised not fully Unresolved; no agreed
established – 16 per cent theoretical model
based on theory
Methodology Lack of standardisation; Five of 113 sound 81 per cent used new Quantitative studies No psychometric data;
simple ad hoc methodology, i.e. met at instrument; of which 61 superficial, simplistic lack of standardisation
instruments least three of study per cent no psychometric and reductionist
requirements data
10 per cent modified
existing instrument
Validity and Poor validity, problems Eight of 165 reported 6 per cent minimum level Many possible sources of Poor, little sustained
reliability with reliability validity and reliability of evidence of validity measurement and evidence of validity;
(tested twice or more) and reliability interpretation error some problems with
reliability
Conclusion Measurement should None of the instruments Little evidence of Use alternative methods Unacceptable research
follow from well met all five of the study reliability or validity, to record patient practice
developed models of requirements plus poor research evaluations of healthcare
satisfaction practice
satisfaction
patient

satisfaction studies
meta-analyses of patient
Summary of published
13

Table I.
A review of
LHS supported services; and the ideal patient is compliant and self-reliant (Thorne et al.,
22,1 2000). Historically the definition and management of healthcare quality has been the
responsibility of the service provider and health services have been largely introspective
in defining and assessing quality, focusing mainly on the technical provider components.
As a result there is comparatively little work investigating patient perceptions of health
service quality (Bell, 2004). There has, however, been some work on clinical governance
14 which has sought to emphasise the importance of the patient perspective but, in general,
this work has been based on areas defined by service providers as important rather than
on what actually matters to patients (Bell, 2004). Further, Weingart et al. (2006) report
that service quality deficiencies in a Boston teaching hospital are so common amongst
medical in-patients that they appear to be the norm.
In contrast, the literature shows significant reductions in the total cost of care when
the patient’s perception of the quality of the service improves, with the dynamics of
poor service delivery often involving wasted effort, repetition, and misuse of skilled
employees (Kenagy et al., 1999). Kenagy et al. (1999) point out that an increase in
functional quality results in improved outcomes generally in medical illness and
specifically in controlled studies of diabetes, hypertension, asthma and rheumatoid
arthritis. Surgical outcomes show similar effects with fewer complications and shorter
hospital stays. Therefore, improvements in functional quality will result in better
health outcomes.

8. Perceived health service quality: the theoretically proven construct

A healthcare service is one that requires high consumer involvement in the
consumption process, and Lengnick-Hall (1995) argued that the traditional health
sector views of technical quality and patient satisfaction were inadequate to manage
the complex relationships between the healthcare provider and the patient.
Importantly, effective healthcare relies significantly on the co-contribution of the
patient to the service delivery process. Studies have also evidenced that compliance
with medical advice and treatment regimes is directly related to the perceived quality
of the service and the subsequent resulting health outcome (O’Connor et al., 1994;
Irving and Dickson, 2004; Sandoval et al., 2006).
Over the past few decades in the services marketing sector, much work has been
undertaken to evaluate the consumer’s perception of service quality, and a number of
service models have been developed, with the gap model (Parasuraman et al., 1985) and
its accompanying SERVQUAL (Parasuraman et al., 1988) having offered significant
advances to the understanding and measurement of perceived service quality.
Perceived health service quality has been studied extensively in the private healthcare
sector; with SERVQUAL having been used frequently in a modified form and
predominantly in the “for profit” American health sector (O’Connor and Trinh, 2000).
More recently, Brady and Cronin (2001) advanced the multidimensional hierarchical
conceptualisation offered by Dabholkar et al. (1996) by combining that model with the
three factor model of Rust and Oliver, and proposed a hierarchical multidimensional
model of service quality. Based on this work, Dagger et al. (2007) have proposed service
quality as a multidimensional, higher order construct, with four overarching
dimensions (interpersonal quality, technical quality, environment quality and
administrative quality) and nine sub-dimensions. They suggest that consumers
assess service quality at a global level, a dimensional level and at a sub-dimensional
level, with each level influencing perceptions at the level above (Figure 1). From their A review of
work with private oncology patients, Dagger et al. (2007) have shown that their model patient
reflects the private patient’s service quality perceptions, and they have developed and
tested a scale for measuring perceived private healthcare service quality. Yet this work satisfaction
has had little impact, as the study and measurement of patient satisfaction continues to
be the key target for consumer research in the health sector.
Further, only a few studies have sought to evaluate the provider understanding of 15
the patient’s perceptions of health service quality (O’Connor et al., 2000), and very few
studies of perceived public healthcare service quality have been undertaken
(Sanchez-Perez et al., 2007). Finally, Brown (2007) editorially highlighted that the
patient is becoming an evermore silent partner in the health care system, as their views
of quality have largely been sidelined by the number of attempts to exclusively
determine patient satisfaction with health care. Research that focuses on strengthening
our understanding of the meaning, measurement, and management of perceived
service quality from the patient’s perspective in healthcare is now arguably
paramount.

9. Conclusion
In the healthcare sector, there is an urgent need for differentiation and standardisation
of the definitions and constructs for satisfaction and perceived health service quality
and their adoption in all future health services research. The continued misuse and
perpetuation of the inter-changeability of terminology not only compromises the worth
of research, it inhibits the possibility of finding much needed answers as how best to
conceive and measure health service quality from the patient’s perspective.
Further, based on the existing evidence that the patient satisfaction is an
unpredictable construct, a focus entirely on perceived service quality, as the definitive
construct, is justified; and given the extremely high intensity nature of the service

Figure 1.
Multi-dimensional
hierarchical model of
perceived service quality
LHS delivery process in the health industry, it would seem that the continuation of the focus
22,1 on patient satisfaction as a measure of service outcome and service quality is seriously
flawed.
Finally, the services marketing literature has identified the importance of perceived
service quality in healthcare and offers some guidance as it has pursued complex
research problems associated with this construct. Therefore cooperative
16 interdisciplinary study and knowledge sharing may offer an excellent vehicle to
derive a standardised and definitive tool for evaluating the patient’s perception of
health service quality.

References
Bell, L. (2004), “Developing service quality in mental health services”, International Journal of
Health Care Quality Assurance, Vol. 17 No. 7, pp. 401-6.
Boyer, L., François, P., Doutre, E., Weil, G. and Labarere, J. (2006), “Perception and use of the
results of patient satisfaction surveys by care providers in a French teaching hospital”,
International Journal for Quality in Health Care, Vol. 18 No. 5, pp. 359-64.
Brady, M.K. and Cronin, J.J.J. (2001), “Some new thoughts on conceptualizing perceived service
quality: a hierarchical approach”, Journal of Marketing, Vol. 65 No. 3, pp. 34-49.
Brown, C. (2007), “Where are the patients in the quality of health care?”, International Journal for
Quality in Health Care, Vol. 19 No. 3, pp. 125-6.
Cleary, P. and Edgman-Levitan, S. (1997), “Health care quality: incorporating consumer
perspectives”, Journal of the American Medical Association., Vol. 278 No. 19, pp. 1608-12.
Clemes, M.D., Ozanne, L.K. and Laurensen, W.L. (2001), “Patients’ perceptions of service quality
dimensions: an empirical examination of health care in New Zealand”, Health Marketing
Quarterly, Vol. 19 No. 1, pp. 3-22.
Coyle, J. and Williams, B. (1999), “Seeing the wood for the trees: defining the forgotten concept of
patient dissatisfaction in the light of patient satisfaction research”, Leadership in Health
Services, Vol. 12 No. 4, pp. i-ix.
Cronin, J.J.J., Brady, M.K. and Hult, G.T.M. (2000), “Assessing the effects of quality, value, and
customer satisfaction on consumer behavioral intentions in service environments”, Journal
of Retailing, Vol. 76 No. 2, pp. 193-216.
Crowe, R., Gage, H., Hampson, S., Hart, J., Kimber, A., Storey, L. and Thomas, H. (2002),
“The measurement of satisfaction with healthcare: implications for practice from a
systematic review of the literature”, Health Technology Assessment, Vol. 6 No. 32, pp. 1-244.
Dabholkar, P.A., Thorpe, D.I. and Rentz, J.Q. (1996), “A measure of service quality for retail
stores”, Journal of the Academy of Marketing Science, Vol. 24 No. 1, pp. 3-16.
Dagger, T.S., Sweeney, J.C. and Johnson, L.W. (2007), “A hierarchical model of health service
quality: scale development and investigation of an integrated model”, Journal of Service
Research, Vol. 10 No. 2, pp. 123-42.
Donabedian, A. (1980), “The definition of quality and approaches to its assessment”,
Explorations in Quality Assessment and Monitoring, Vol. 1, Health Administration Press,
Ann Arbor, MI.
Fitzpatrick, R. and Hopkins, A. (1983), “Problems in the conceptual framework of patient
satisfaction research: an empirical exploration”, Sociology of Health & Illness, Vol. 5 No. 3,
pp. 297-311.
Fox, J.G. and Storms, D.M. (1981), “A different approach to sociodemographic predictors of A review of
satisfaction with health care”, Social Science & Medicine. Part A: Medical Sociology, Vol. 15
No. 5, pp. 557-64. patient
Gilbert, G.R. and Veloutsou, C. (2006), “A cross-industry comparison of customer satisfaction”, satisfaction
The Journal of Services Marketing, Vol. 20 No. 5, pp. 298-307.
Gilbert, G.R., Veloutsou, C., Goode, M.M.H. and Moutinho, L. (2004), “Measuring customer
satisfaction in the fast food industry: a cross-national approach”, The Journal of Services 17
Marketing, Vol. 18 Nos 4/5, pp. 371-83.
Gonzalez, N., Quintana, J.M., Bilbao, A., Escobar, A., Aizpuru, F., Thompson, A., Esteban, C.,
Sebastian, J.A.S. and de la Sierra, E. (2005), “Development and validation of an in-patient
satisfaction questionnaire”, International Journal for Quality in Health Care, Vol. 17 No. 6,
pp. 465-72.
Gotlieb, J.B., Grewal, D. and Brown, S.W. (1994), “Consumer satisfaction and perceived quality:
complimentary or divergent constructs”, Journal of Applied Psychology, Vol. 79 No. 6,
pp. 875-85.
Hardy, G., West, M. and Hill, F. (1996), “Components and predictors of patient satisfaction”,
British Journal of Health Psychology, Vol. 1, pp. 65-85.
Hawthorne, G. (2006), Review of Patient Satisfaction Measures, Australian Goverment
Department of Health and Ageing, Canberra.
Heidegger, T., Saal, D. and Nuebling, M. (2006), “Patient satisfaction with anaesthesia care: what
is patient satisfaction, how should it be measured, and what is the evidence for assuring
high patient satisfaction”, Best Practice and Research Clinical Anaesthesiology, Vol. 20
No. 2, pp. 331-46.
Hill, R. (2003), Satisfaction, Wiley & Sons, Milton Keynes.
Hood, C. (1995), “The new public management in the 1980s: variations on a theme”, Journal of
Accounting, Organizations and Society, Vol. 20 Nos 2/3, pp. 93-109.
Hulka, B., Zyzanski, S., Cassel, J. and Thompson, S. (1970), “Scale for the measurement of
attitudes towards physicians and primary medical care”, Medical Care, Vol. 8 No. 5,
pp. 429-36.
Irving, P. and Dickson, D. (2004), “Empathy: towards a conceptual framework for health
professionals”, International Journal of Health Care Quality Assurance, Vol. 17 Nos 4/5,
pp. 212-20.
Kenagy, J.W., Berwick, D.M. and Shore, M.F. (1999), “Service quality in health care”, Journal of
the American Medical Association, Vol. 281 No. 7, pp. 661-5.
Kleinsorge, I.K. and Koenig, H.F. (1991), “The silent customers: measuring customer satisfaction
in nursing homes”, Journal of Health Care Marketing, Vol. 11 No. 4, pp. 2-13.
Larsen, D.L., Attkisson, C.C., Hargreaves, W.A. and Nguyen, T.D. (1979), “Assessment of
client/patient satisfaction: development of a general scale”, Evaluation and Program
Planning, Vol. 2 No. 3, pp. 197-207.
Lee, P.-M., Khong, P. and Ghista, D.N. (2006), “Impact of deficient healthcare service quality”,
The TQM Magazine, Vol. 18 No. 6, pp. 563-71.
Lengnick-Hall, C.A. (1995), “The patient as the pivot point for quality in health care delivery”,
Hospital & Health Services Administration, Vol. 40 No. 1, pp. 25-39.
Lin, B. and Kelly, E. (1995), “Methodological issues in patient satisfaction surveys”, International
Journal of Health Care Quality Assurance, Vol. 8 No. 6, p. 32.
Linder-Pelz, S. (1982), “Toward a theory of patient satisfaction”, Social Science & Medicine,
Vol. 16 No. 5, pp. 577-82.
LHS Meterko, M., Nelson, E.C., Rubin, H.R., Batalden, P., Berwick, D.M., Hays, R.D. and Ware, J.E. Jr
(1990), “Patient judgments of hospital quality: report of a pilot study”, Medical Care, Vol. 28
22,1 No. 9, pp. S1-S56.
Nguyen, T.D., Attkisson, C.C. and Stegner, B.L. (1983), “Assessment of patient satisfaction:
development and refinement of a service evaluation questionnaire”, Evaluation and
Program Planning, Vol. 6 Nos 3-4, pp. 299-313.
18 O’Connor, S.J. and Shewchuk, R. (2003), “Commentary – patient satisfaction: what is the point?”,
Health Care Management Review, Vol. 28 No. 1, pp. 21-4.
O’Connor, S.J. and Trinh, H.Q. (2000), “Perceptual gaps in understanding patient expectations for
health care service quality”, Health Care Management Review, Vol. 25 No. 2, pp. 7-23.
O’Connor, S.J., Shewchuk, R.M. and Carney, L.W. (1994), “The great gap”, Journal of Health Care
Marketing, Vol. 14 No. 2, pp. 32-9.
O’Connor, S.J., Trinh, H.Q. and Shewchuck, R.M. (2000), “Perceptual gaps in understanding
patient expectations for health care service quality”, Health Care Management Review,
Vol. 25 No. 2, pp. 7-23.
Oliver, R.L. (1981), “Measurement and evaluation of satisfaction processes in retail settings”,
Journal of Retailing, Vol. 57 No. 3, pp. 25-48.
Oliver, R.L. (1989), “Processing of the satisfaction response in consumption: a suggested
framework and research propositions”, Journal of Customer Satisfaction, Dissatisfaction
and Complaining Behavior, Vol. 2, pp. 1-16.
Oliver, R.L. (1997), Satisfaction: A Behavioral Perspective on the Consumer, McGraw-Hill, New
York, NY.
Parasuraman, A., Zeithaml, V.A. and Berry, L.L. (1985), “A conceptual model of service quality
and its implications for future research”, Journal of Marketing, Vol. 49 No. 4, pp. 41-50.
Parasuraman, A., Zeithaml, V.A. and Berry, L.L. (1988), “SERVQUAL: a multiple-item scale for
measuring consumer perceptions of service quality”, Journal of Retailing, Vol. 64 No. 1,
pp. 12-40.
Pascoe, G.C. (1983), “Patient satisfaction in primary health care: a literature review and analysis”,
Evaluation and Program Planning, Vol. 6 Nos 3-4, pp. 185-210.
Sanchez-Perez, M., Sanchez-Fernandez, R., Marin-Carrillo, G.M. and Gazquez-Abad, J.C. (2007),
“Service quality in public services as a segmentation variable”, Service Industries Journal,
Vol. 27 No. 4, pp. 355-69.
Sandoval, G.A., Brown, A.D., Sullivan, T. and Green, E. (2006), “Factors that influence cancer
patients’ overall perceptions of the quality of care”, International Journal for Quality in
Health Care, Vol. 18 No. 4, pp. 266-74.
Sitzia, J. (1999), “How valid and reliable are patient satisfaction data? An analysis of 195 studies”,
International Journal for Quality in Health Care, Vol. 11 No. 4, pp. 319-28.
Sofaer, S. and Firminger, K. (2005), “Perceptions of the quality of health services”, Annual Review
of Public Health, Vol. 26 No. 1, pp. 513-59.
Strasser, S., Aharony, L. and Greenberger, D. (1993), “The patient satisfaction process: moving
toward a comprehensive model”, Medical Care Review, Vol. 50 No. 2, pp. 219-45.
Taylor, S.A. (1999), “Distinguishing service quality from patient satisfaction in developing health
care marketing strategies”, Hospital and Health Services Administration, Vol. 39 No. 2,
pp. 221-36.
Thorne, S.E., Ternulf Nyhlin, K. and Paterson, B.L. (2000), “Attitudes toward patient expertise in
chronic illness”, International Journal of Nursing Studies, Vol. 37 No. 4, pp. 303-11.
Turris, S.A. (2005), “Unpacking the concept of patient satisfaction: a feminist analysis”, Journal A review of
of Advanced Nursing, Vol. 50 No. 3, pp. 293-8.
Urden, K.D. (2002), “Patient satisfaction measurement: current issues and implications”,
patient
Outcomes Management, Vol. 6 No. 6, pp. 125-31. satisfaction
van Campen, C., Sixma, H., Friele, R.D., Kerssens, J.J. and Peters, L. (1995), “The quality of care
and patient satisfaction: a review of measuring instruments”, Medical Care Research and
Review, Vol. 52 No. 1, pp. 109-33. 19
Ware, J.E. Jr and Snyder, M.K. (1975), “Dimensions of patient attitudes regarding doctors and
medical care services”, Medical Care, Vol. 13 No. 8, pp. 669-82.
Ware, J.E., Snyder, M.K., Wright, W.R. and Davies, A.R. (1983), “Defining and measuring patient
satisfaction with medical care”, Evaluation and Program Planning, Vol. 6 Nos 3-4,
pp. 247-63.
Weingart, S.N., Pagovich, O., Sands, D.Z., Li, J.M., Aronson, M.D., Davis, R.B., Phillips, R.S. and
Bates, D.W. (2006), “Patient-reported service quality on a medicine unit”, International
Journal for Quality in Health Care, Vol. 18 No. 2, pp. 95-101.
Williams, B. (1994), “Patient satisfaction: a valid concept?”, Social Science & Medicine, Vol. 38
No. 4, pp. 509-16.
Yi, Y. (1990), A Critical Review of Customer Satisfaction, American Marketing Association,
Chicago, IL.

Corresponding author
Liz Gill can be contacted at: lgil9930@mail.usyd.edu.au

To purchase reprints of this article please e-mail: reprints@emeraldinsight.com

Or visit our web site for further details: www.emeraldinsight.com/reprints
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

View publication stats